Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA ; University of Missouri-Kansas City , Kansas City, Missouri , USA ; University of Kansas Medical Center , KansasCity, Kansas , USA.
Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.
BMJ Open Diabetes Res Care. 2014 Oct 7;2(1):e000039. doi: 10.1136/bmjdrc-2014-000039. eCollection 2014.
Poor glycemic control early in the course of type 1 diabetes mellitus (T1DM) increases the risk for microvascular complications. However, predictors of deteriorating control after diagnosis have not been described, making it difficult to identify high-risk patients and proactively provide aggressive interventions.
We examined whether diagnostic age, gender, and race were associated with deteriorating glycemic control during the first 5 years after diagnosis.
2218 pediatric patients with T1DM.
We conducted a longitudinal cohort study of pediatric patients with T1DM from the Midwest USA, 1993-2009, evaluating within-patient glycated hemoglobin (HbA1c) trajectories constructed from all available HbA1c values within 5 years of diagnosis.
52.6% of patients were male; 86.1% were non-Hispanic Caucasian. The mean diagnostic age was 9.0±4.1 years. The mean number of HbA1c values/year/participant was 2.4±0.9. HbA1c trajectories differed markedly across age groups, with older patients experiencing greater deterioration than their younger counterparts (p<0.001). HbA1c trajectories, stratified by age, varied markedly by race (p for race×diagnostic age <0.001). Non-Hispanic African-American patients experienced higher initial HbA1c (8.7% vs 7.6% (71.6 vs 59.6 mmol/mol); p<0.001), and greater deterioration in HbA1c than non-Hispanic Caucasian patients across diagnostic ages (rise of 2.04% vs 0.99% per year (22.3 vs 10.8 mmol/mol/year); p<0.0001).
Older diagnostic age and black race are major risk factors for deterioration in glycemic control early in the course of T1DM. These findings can inform efforts to explore the reasons behind these differences and develop preventive interventions for high-risk patients.
1 型糖尿病（T1DM）病程早期血糖控制不佳会增加微血管并发症的风险。然而，尚未明确诊断后血糖控制恶化的预测因素，这使得难以识别高危患者并主动提供强化干预措施。
我们研究了诊断时的年龄、性别和种族是否与诊断后 5 年内血糖控制恶化有关。
2218 例美国中西部儿科 T1DM 患者。
我们对来自美国中西部的儿科 T1DM 患者进行了一项纵向队列研究，1993-2009 年，从所有诊断后 5 年内可获得的糖化血红蛋白（HbA1c）值中构建了每个患者的 HbA1c 轨迹。
52.6%的患者为男性，86.1%为非西班牙裔白种人。诊断时的平均年龄为 9.0±4.1 岁。平均每位患者每年的 HbA1c 检测次数为 2.4±0.9。不同年龄组的 HbA1c 轨迹差异显著，年龄较大的患者较年轻患者恶化程度更大（p<0.001）。按年龄分层的 HbA1c 轨迹在种族之间差异显著（p<0.001）。非西班牙裔非裔美国患者的初始 HbA1c 较高（8.7%比 7.6%（71.6 比 59.6mmol/mol）；p<0.001），且在所有诊断年龄组中，HbA1c 的恶化程度均高于非西班牙裔白种人患者（每年升高 2.04%比 0.99%（22.3 比 10.8mmol/mol/年）；p<0.0001）。
诊断时年龄较大和黑种人是 T1DM 病程早期血糖控制恶化的主要危险因素。这些发现有助于了解这些差异背后的原因，并为高危患者制定预防干预措施。
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